Who is to say for sure how much pain I have right now, I had yesterday morning, or will have this afternoon? Only I can know for sure the pain I am feeling—and I can lie, to myself and to others. Herein lies the greatest challenge of addiction to pain medication. There is no objective measuring tool for pain. The best we can do is to ask the person to rate his or her own pain on a scale of 1 to 10, with all the accuracy that can be expected from such a subjective assessment, which isn’t very much because pain can always feel more intense than it actually is, physically or sometimes just psychologically.
The sad result of the greater availability of pain medication, its greater potency, the beneficial effects felt by the individual by taking what amounts to a legal hit of morphine is an ever increasing number of people who are dying from abusing or misusing pain medication. Among some groups, deaths from prescription drug overdoses are more than ten times higher than they were in the late 1960s. These are the results of an age-period-cohort analysis using data from the US Vital Statistics and the US Census, available online.
In the absence of significant pain, prescription painkillers are ingested because of their very powerful relaxing effects on the central nervous system and for the sensations of well-being that characterize their action. The presence of hydrocodone, which is the equivalent of synthetic opium, in these drugs makes them highly addictive. The first signs of a painkiller overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in the upper stomach, dark urine, and yellowing of the skin or the whites of the eyes. Overdose symptoms may also include extreme drowsiness, pinpoint pupils, cold and clammy skin, muscle weakness, fainting, weak pulse, slow heart rate, coma, blue lips, shallow breathing, or no breathing.
The rapid increase in mortality due to accidental poisoning that has been observed since 2000 is almost tenfold for whites and threefold for blacks over the study period. This appears to result at least in part from the coming of age of baby boomers who, as they age, are becoming addicted to prescription medications, most especially pain killers. The majority of prescription drug abuse involves painkillers, according to the Drug Enforcement Administration. In the US, Vicodin (containing acetaminophen and hydrocodone) is the most commonly abused prescription drug.
The greatest proportion of overdoses appears to occur in people in their 40s and 50s. While in 1968 about one per 100,000 white women in their early 50s died from accidental poisoning, the number has risen to 15 per 100,000 in 2007. Among black women of the same age, accidental poisoning deaths increased from about two per 100,000 to almost 17 per 100,000.
What’s the fix for this nationwide epidemic? In the absence of an objective pain measure, it is hard to imagine how anyone can take exception to the screams of pain that can come from someone who is in the process of becoming addicted to pain medication, or already is. Many doctors have taken the no-hassle course of prescribing, rather than questioning the veracity of the patient’s pain. Many other medical practitioners, such as dentists and surgeons, have taken to dispensing large quantities of “samples” to patients who have had even the simplest procedure, “just in case you feel any pain.” Of course, the patient takes the stuff, the pain (if any) goes away, and the powerful effects of the drug go to work by inducing a high that feels incredibly good. At this point, and in many sad cases, only a few short steps separate the patient from the addict.
More recently, the DEA has cracked down on pharmacies and doctors, with the intent of reducing the supply of these medications. More needs to be done to stop the flow, but also and most especially to educate the public on the potential addictive nature of these substances. They do work extremely well against pain, but at what cost?